Features of clinical symptoms and possibilities of early diagnosis of acute pancreatitis in pregnant women
DOI:
https://doi.org/10.15574/PP.2024.3(99).4654Keywords:
acute pancreatitis, diagnosis, pregnancyAbstract
Traditional methods of diagnosing acute pancreatitis (AP) in pregnant women do not differ from diagnostic criteria in the non-pregnant population. Instead, physiological changes during pregnancy and the similarity of clinical manifestations of the disease with typical pregnancy complications are associated with difficulties in diagnosis, late diagnosis, and deterioration of treatment results.
Аim - to analyze the diagnostic value of the criteria for diagnosing AP in pregnant women.
Materials and methods. 123 pregnant women aged 18 to 42 years with a gestation period of 12 to 37 weeks (on average - 21.95±8.81 weeks) with AP were examined: I (control) group - 62 pregnant women, using traditional methods of treatment and diagnosis, and II (main) group - 61 pregnant women, using the developed diagnostic and treatment algorithm. Statistical data processing was carried out using the SPSS 21 program.
Results. Our results show that the triad of clinical symptoms of AP (typical "pancreatic" pain, nausea and vomiting, paralytic intestinal obstruction) are found in only 29% of pregnant women. The frequency of painless forms of AP is 29.1%. The diagnostic sensitivity and specificity of blood leucocytosis for AP in pregnant women is 75.8% and 54.8%, an increase in the level of serum amylase 3 times about the upper limit of average - 74.2% and 68.7%, lipase - 77.4% and 90.3%, respectively. 48.4% of pregnant women had sonographic changes characteristic of AP within the first day from the moment of disease manifestation. In the group ІІ, when applying the diagnostic and treatment algorithm, 100% of patients had acute pancreatitis at an early stag
Conclusions. Our results indicate that early diagnosis of AP in pregnant women using generally accepted diagnostic criteria is possible in no more than 48.8% of cases, which suggests the need to improve early diagnosis of the disease in this category of patients.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
References
Abdullah B, Kathiresan Pillai T, Cheen LH, Ryan RJ. (2015). Severe acute pancreatitis in pregnancy. Case Rep Obstet Gynecol. 2015: 239068. https://doi.org/10.1155/2015/239068; PMid:25628906 PMCid:PMC4299559
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al. (2013). Classification of acute pancreatitis - 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 62(1): 102-111. https://doi.org/10.1136/gutjnl-2012-302779; PMid:23100216
Cai E, Czuzoj-Shulman N, Abenhaim HA. (2021). Perinatal outcomes in pregnancies complicated by acute pancreatitis. J Perinat Med. 50(1): 68-73. https://doi.org/10.1515/jpm-2020-0580; PMid:34523294
Cruciat G, Nemeti G, Goidescu I, Anitan S, Florian A. (2020). Hypertriglyceridemia triggered acute pancreatitis in pregnancy - diagnostic approach, management and follow-up care. Lipids Health Dis. 19(1): 2. https://doi.org/10.1186/s12944-019-1180-7; PMid:31901241 PMCid:PMC6942404
Fu CY, Yeh CN, Hsu JT, Jan YY, Hwang TL. (2007). Timing of mortality in severe acute pancreatitis: experience from 643 patients. World J Gastroenterol. 13(13): 1966-1969. https://doi.org/10.3748/wjg.v13.i13.1966; PMid:17461498 PMCid:PMC4146974
Gupta M, Liti B, Barrett C, Thompson PD, Fernandez AB. (2022). Prevention and Management of Hypertriglyceridemia-Induced Acute Pancreatitis During Pregnancy: A Systematic Review. Am J Med. 135(6): 709-714. https://doi.org/10.1016/j.amjmed.2021.12.006; PMid:35081380
Headley AJ, Blechman AN. (2008). Diagnosis of macroamylasemia in a pregnant patient. J Natl Med Assoc. 100(11): 1359-1361. https://doi.org/10.1016/S0027-9684(15)31516-9; PMid:19024234
Hot S, Eğin S, Gökçek B, Yeşiltaş M, Karakaş DÖ. (2019). Acute biliary pancreatitis during pregnancy and in the post-delivery period. Ulus Travma Acil Cerrahi Derg. 25(3): 253-258. https://doi.org/10.14744/tjtes.2019.03846
Hughes DL, Hughes A, White PB, Silva MA. (2021). Acute pancreatitis in pregnancy: meta-analysis of maternal and fetal outcomes. Br J Surg. 109(1): 12-14. https://doi.org/10.1093/bjs/znab221; PMid:34179950 PMCid:PMC10364714
Igbinosa O, Poddar S, Pitchumoni C. (2013). Pregnancy associated pancreatitis revisited. Clin Res Hepatol Gastroenterol. 37(2): 177-181. https://doi.org/10.1016/j.clinre.2012.07.011; PMid:22959401
Johnson A, Cluskey B, Hooshvar N, Tice D, Devin C, Kao E et al. (2015). Significantly elevated serum lipase in pregnancy with nausea and vomiting: acute pancreatitis or hyperemesis gravidarum? Case Rep Obstet Gynecol. 2015: 359239. https://doi.org/10.1155/2015/359239; PMid:25709846 PMCid:PMC4332755
Liberis A, Petousis S, Tsikouras P. (2021). Lipid Disorders in Pregnancy. Curr Pharm Des. (36): 3804-3807. https://doi.org/10.2174/1381612827666210421103245; PMid:33882801
Lopez-Lopez V, Navaratne L, Ferreras D, Gil PJ, Bansal VK, Mattila A, (2023). Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review. Langenbecks Arch Surg. 408(1): 45. https://doi.org/10.1007/s00423-023-02793-9; PMid:36662260
Luo L, Zen H, Xu H, Zhu Y, Liu P, Xia L et al. (2018). Clinical characteristics of acute pancreatitis in pregnancy: experience based on 121 cases. Arch Gynecol Obstet. 297(2): 333-339. https://doi.org/10.1007/s00404-017-4558-7; PMid:29164335 PMCid:PMC5778161
Mądro A. (2022). Pancreatitis in Pregnancy-Comprehensive Review. Int J Environ Res Public Health. 19(23): 16179. https://doi.org/10.3390/ijerph192316179; PMid:36498253 PMCid:PMC9737239
Magudapathi C, Shanthi S, Palanisamy R. (2020). Pancreatitis in Pregnancy: Case Series for 5 Years. J Obstet Gynaecol India. 70(2): 169-172. https://doi.org/10.1007/s13224-019-01267-7; PMid:32255957 PMCid:PMC7109209
Mamchich VI, Golyanovsky OV, Kandaurova IV, Pylypenko TYu, Yosypenko MO, Litvinets YuO. (2015). Diagnosis and treatment peculiarities of acute pancreatitis in pregnant. Khirurhiia Ukrainy. 4: 28-32.
Maringhini A, Rossi M, Patti R, Maringhini M, Vassallo V. (2024). Acute Pancreatitis during and after Pregnancy: A Review. J Clin Med. 13(7): 2028. https://doi.org/10.3390/jcm13072028; PMid:38610793 PMCid:PMC11012882
Moon EK, Wang W, Newman JS, Bayona-Molano MP. (2013). Challenges in interventional radiology: the pregnant patient. Semin Intervent Radiol. 30(4): 394-402. https://doi.org/10.1055/s-0033-1359734; PMid:24436567 PMCid:PMC3835597
Robertson KW, Stewart IS, Imrie CW. (2006). Severe acute pancreatitis and pregnancy. Pancreatology. 6(4): 309-315. https://doi.org/10.1159/000092694; PMid:16636606
Shlapak IP, Mishchenko DL, Datsiuk OI, Tytarenko NV. (2007). Acute pancreatitis: priorities in intensive care. Ukrainskyi zhurnal ekstremalnoi medytsyny imeni H. O. Mozhaieva. 3: 56-60.
Tenner S, Baillie J, DeWitt J, Vege SS, American College of Gastroenterology. (2013). American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 108(9): 1400-1415; 1416. https://doi.org/10.1038/ajg.2013.218; PMid:23896955
Wang PI, Chong ST, Kielar AZ, Kelly AM, Knoepp UD, Mazza MB, Goodsitt MM. (2012). Imaging of pregnant and lactating patients: part 1, evidence-based review and recommendations. AJR Am J Roentgenol. 198(4): 778-84. https://doi.org/10.2214/AJR.11.7405; PMid:22451541
Wilcox CM, Varadarajulu S, Morgan D, Christein J. (2010). Progress in the management of necrotizing pancreatitis. Expert Rev Gastroenterol Hepatol. 4(6): 701-708. https://doi.org/10.1586/egh.10.75; PMid:21108589
Working Group IAP/APA Acute Pancreatitis Guidelines. (2013). IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 13; 4 Suppl 2: e1-15. https://doi.org/10.1016/j.pan.2013.07.063
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Ukrainian Journal of Perinatology and Pediatrics
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “Ukrainian Journal of Perinatology and Pediatrics” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
